Tuesday, August 21, 2007

Many, many women in India, especially poor women, go through labor alone. Government and even private hospitals do not allow anyone to accompany the laboring woman. This practice is not only ludicrous and inhumane, it makes no sense given what we know about how women who are supported in labor have better health outcomes, as do their babies. I think this should be one of the first issues to be tackled by our newly forming Bangalore Birth Network (BBN)!Women happier with childbirth when accompanied

NEW YORK (Reuters Health) - Women who go through labor and childbirth with a companion of their choice are more satisfied with the experience, and the care they receive, than women who deliver alone, Brazilian researchers report.

Furthermore, the presence of a companion did not create any safety issues, In fact, women with a companion on hand were about half as likely as unaccompanied women to have amniotic fluid stained with fetal stool -- meconium -- which can be dangerous to infants if it is inhaled.

While having a companion to provide support during labor and delivery is accepted practice in much of the world, many health facilities do not allow companions or discourage their presence, Dr. Odalea M. Bruggemann of the Federal University of Santa Catarina in Florianopolis and her colleagues note. This is especially common in the developing world, they add.

Bruggemann and her team randomly assigned 212 women to solo labor or labor with a companion of their choice, to compare childbirth experiences.

About half of the accompanied woman (47 percent) chose their partner or the child's father, while 30 percent chose their mother and 23 percent chose another female relative or a friend.

The women who received support from a companion were significantly more satisfied with labor and delivery than those who went through childbirth alone. They were eight times more likely to be satisfied with their labor experience and nearly six times as likely to be satisfied with delivery.

The accompanied women were also more satisfied with their medical care and medical guidance during labor and delivery. "Perhaps because there was someone else in the room, medical staff were more forthcoming and user-friendly than when no support person was present," the researchers note in their report in the online journal Reproductive Health.

Women with companions were 49 percent less likely to have amniotic fluid stained with meconium than women who delivered on their own. This may have been because they were less anxious and fearful, Bruggemann and her team suggest.

"If on one hand there is a general belief that a labor companion has always positive effects, there are, on the other hand, still a lot of health facilities where companions are not allowed, especially in developing settings," the researchers write. "It is expected that the results of this study could help providers to acknowledge and respect women's rights during birth."

SOURCE: Reproductive Health, July 6, 2007.

Copyright 2007 Reuters News Service. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Monday, August 20, 2007

America's "let them cry" attitude toward children may lead to more fears and tears among adults, according to two Harvard Medical School researchers.

Instead of letting infants cry, American parents should keep their babies close, console them when they cry, and bring them to bed with them, where they'll feel safe, according to Michael L. Commons and Patrice M. Miller, researchers at the Medical School's Department of Psychiatry.

The pair examined childrearing practices here and in other cultures and say the widespread American practice of putting babies in separate beds -- even separate rooms -- and not responding quickly to their cries may lead to incidents of post-traumatic stress and panic disorders when these children reach adulthood.

The early stress resulting from separation causes changes in infant brains that makes future adults more susceptible to stress in their lives, say Commons and Miller.

"Parents should recognize that having their babies cry unnecessarily harms the baby permanently," Commons said. "It changes the nervous system so they're overly sensitive to future trauma."

The Harvard researchers' work is unique because it takes a cross-disciplinary approach, examining brain function, emotional learning in infants, and cultural differences, according to Charles R. Figley, director of the Traumatology Institute at Florida State University and editor of The Journal of Traumatology.

"It is very unusual but extremely important to find this kind of interdisciplinary and multidisciplinary research report," Figley said. "It accounts for cross-cultural differences in children's emotional response and their ability to cope with stress, including traumatic stress."

Figley said Commons and Miller's work illuminates a route of further study and could have implications for everything from parents' efforts to intellectually stimulate infants to practices such as circumcision.

Commons has been a lecturer and research associate at the Medical School's Department of Psychiatry since 1987 and is a member of the Department's Program in Psychiatry and the Law.

Miller has been a research associate at the School's Program in Psychiatry and the Law since 1994 and an assistant professor of psychology at Salem State College since 1993. She received master's and doctorate degrees in human development from the Graduate School of Education.

The pair say that American childrearing practices are influenced by fears that children will grow up dependent. But they say that parents are on the wrong track: physical contact and reassurance will make children more secure and better able to form adult relationships when they finally head out on their own.

"We've stressed independence so much that it's having some very negative side effects," Miller said.

The two gained the spotlight in February when they presented their ideas at the American Association for the Advancement of Science's annual meeting in Philadelphia.

Commons and Miller, using data Miller had worked on that was compiled by Robert A. LeVine, Roy Edward Larsen Professor of Education and Human Development, contrasted American childrearing practices with those of other cultures, particularly the Gusii people of Kenya. Gusii mothers sleep with their babies and respond rapidly when the baby cries.

"Gusii mothers watching videotapes of U.S. mothers were upset by how long it took these mothers to respond to infant crying," Commons and Miller said in their paper on the subject.

The way we are brought up colors our entire society, Commons and Miller say. Americans in general don't like to be touched and pride themselves on independence to the point of isolation, even when undergoing a difficult or stressful time.

Despite the conventional wisdom that babies should learn to be alone, Miller said she believes many parents "cheat," keeping the baby in the room with them, at least initially. In addition, once the child can crawl around, she believes many find their way into their parents' room on their own.

American parents shouldn't worry about this behavior or be afraid to baby their babies, Commons and Miller said. Parents should feel free to sleep with their infant children, to keep their toddlers nearby, perhaps on a mattress in the same room, and to comfort a baby when it cries.

"There are ways to grow up and be independent without putting babies through this trauma," Commons said. "My advice is to keep the kids secure so they can grow up and take some risks."

Besides fears of dependence, the pair said other factors have helped form our childrearing practices, including fears that children would interfere with sex if they shared their parents' room and doctors' concerns that a baby would be injured by a parent rolling on it if the parent and baby shared the bed. Additionally, the nation's growing wealth has helped the trend toward separation by giving families the means to buy larger homes with separate rooms for children.

The result, Commons and Miller said, is a nation that doesn't like caring for its own children, a violent nation marked by loose, nonphysical relationships.

"I think there's a real resistance in this culture to caring for children," Commons said. But "punishment and abandonment has never been a good way to get warm, caring, independent people."

Thursday, August 16, 2007

If you or anyone you know is interested in joining our efforts, please contact me!

The Bangalore Birth Network (BBN) is a group of professionals and concerned citizens in Bangalore who share the beliefs that:

• Pregnancy and childbirth are normal physiological processes as well as social events in the life of a woman and her family.

• Women, not medical practitioners, are the primary caregivers for themselves, their fetuses, newborns and families.

• Every woman should be treated with respect in every phase of her care from pregnancy through postpartum. Respect includes, but is not limited to complete, unbiased information about tests, treatments, and procedures, fully informed consent, preservation of privacy, and polite respectful communications by all involved with her care.

• Intervention in the process and the application of technology are only justified when their use can be shown to enhance wellbeing and improve outcome for a particular mother and her baby. Routine protocols not based on research evidence should be avoided. Maternity care should be grounded in evidence, and care providers should be accountable to the mother and family for the mental and physical outcomes resulting from their actions or inactions.

• A primary maternity care system that offers a variety of options in prenatal care and birth settings and in choice of caregivers is essential to meeting women’s needs. Each birthing woman has individual needs, and it is her right to select the care provider and setting for birth that best fits those needs.

• Professionals and citizens must actively promote the allocation of resources towards measures that support the basic needs of women and their babies, while reducing the over-use of expensive obstetric technology.

• Every woman has the right to accessible, affordable, proficient maternity care.

In keeping with this position, the Bangalore Birth Network will:

• Promote childbirth practices and guidelines for care which enhance the normal physiological process; • Promote the allocation of resources towards measures which support the basic needs of women and their babies as a priority, such as improved nutrition and social support during pregnancy; • Continuously evaluate intervention and the use of technology in midwifery and obstetrical practice and take measures to avoid unnecessary interference; • Provide information and education to women and their families that enhances the understanding of birth as a normal life process and enables them to make informed decisions; and• Promote research and training in evidence-based maternity care coalition-building, communications, and networking with other organizations to achieve our vision.

Wednesday, August 8, 2007

ROSWELL, Georgia (CNN) -- The lights were dimmed, soft music was playing and a scented candle burned on the counter. In the center of it all was Julie Trotter -- moaning through hard labor contractions.

Doula Kai Martin Short works to ease Julie Trotter's pain during labor.

For more than six hours, Trotter, a 23-year-old from Duluth, Georgia, tried different techniques to ease the pain of natural childbirth. Not only was her husband offering encouragement, but so was her doula, Kai Martin Short.

"She definitely was a lifesaver for sure," Trotter says. "She used a lot of counter-pressure through each contraction, and that helped so much."

Doula is a Greek word meaning "woman's servant." Part birthing coach, part mother's assistant, doulas are showing up in more delivery rooms than ever before.

Short, from Atlanta, Georgia, is among 2,500 certified doulas in the United States.

"Doulas trust birth and are not afraid of it even when the mom and dad get afraid," Short said. "We're there to just say things are fine; you're doing great; this is all normal."Video Health Minute: Watch how a doula helps a woman through labor »

Short offers more than comforting words. For a flat fee of $700 per client, she meets with the parents before the baby's due date to talk about their expectations and to share techniques to be used during labor. She is by the mother's side in the delivery room and visits the parents at home after the baby is born to offer advice on such topics as breastfeeding.

In her three years as a doula, Short has attended more than 30 births. Her training with a group called DONA International involved 26 hours of instruction on pregnancy, childbirth and comfort measures. "Whatever [mothers] need, whether it be changing positions, encouragement, massage or saying comforting words, there are so many things we do to help with the process," Short said.

Short tries to create a calm atmosphere in the delivery room with music and candles. Throughout the labor, she massages the birthing mother's back and rubs her head. Another one of her tricks to relieve pain involves having the woman sit on a big rubber exercise ball during contractions.

She encourages the father or other family members to get involved in the process and shows them how to help the mother breathe through contractions.

"I think it's really hard for a loved one to see their loved one in pain," Short said. "They don't really know how to help them."

While Short has plenty of advice for parents, she has no medical training and is not supposed to offer a medical opinion. She does not take the place of a doctor, midwife or nurse. Her role is to strictly work with the family and motivate the mother during labor and delivery.

But Dr. Sean Lambert, an OB/GYN who delivered Trotter's baby at North Fulton Hospital in Alpharetta, Georgia, says that sometimes, doulas can cross the line.

"It's almost as if some women and some couples have turned to them for too much advice and guidance," he said. "Occasionally, it will cut across what we recommend on a medical basis."

Short says she's never had any clashes with medical professionals. "Really, it's separate roles," she said. But she can understand how the relationship can get tricky. "It can be territorial sometimes if the doula is a little bit more strong-minded or opinionated."

Short encourages her clients to ask questions, and she's careful in her approach to the answers she gives.

Ten days after the birth of her son, Braydon, Trotter reflected on the experience. "It was a perfect one in my eyes," she said. "I think having a doula definitely would be helpful for anybody, and I wouldn't change anything about the birth."

Short enjoys seeing new families come to life and concludes, "The best part for me is helping women realize what their bodies can do. Just having that support can make all the difference."

Judy Fortin is a correspondent with CNN Medical News. Producer Leslie Wade contributed to this report.

In a previous post, I linked to an article about how children under two benefit more from human interaction than watching television. Here's another article with new research on how Baby Einstein videos might actually delay language development instead of enhance it.

Monday, August 6, 2007

The US centers for disease control (CDC) just came out with a survey that found that only about 30% of new moms breastfeed exclusively at three months of age, and at six months, only 11% are breastfeeding exclusively. Why are these number so low when we know that breastfeeding results in better health outcomes for both mothers and babies?! I think it points to a few problems:

1) Traumatic birth experiences for women and babies: the cesarean rate is at an all-time high in the US, at 30%. In India it's likely to be double that in many hospitals. Babies born by cesarean are often separated from their mamas for several hours, making establishing breastfeeding particularly challenging. Even women who have vaginal births are often separated from their babies due to unnecessary hospital routines and policies.

2) Lack of support for breastfeeding moms: I've seen many women have trouble getting their newborn to latch on properly. Nurses in hospitals are not trained as Lactation Consultants, and when a hospital does have an LC, often they are overworked and extremely difficult to track down. I realize this varies by hospital, but certainly in India there are no LCs in any hospital, and it is very hard for women to get support early on.

3) An emphasis on independence: well-meaning advice-givers stress the importance of not being held too much, feeding schedules, and baby sleeping alone in a crib. These parenting practices make it difficult to breastfeed.

4) Short maternity leave: going back to work--often after only six weeks--means separation between mama and baby for many, many hours. Pumping is not always easy or convenient, and many nursing mothers face discrimination at work.

5) The insidious nature of formula companies' advertisements: many women in hospitals receive free formula samples in their discharge packs instead of helpful information on breastfeeding. Formula companies distribute posters and pamphlets to doctors and hospitals to leave in their waiting rooms. Because these materials are so prolific, women get the message that bottle-feeding is the norm.

As long as women receive mixed messages and are not properly educated, encouraged or supported, we can't expect these rates to go up. If E've totally depressed you, or even if i haven't, please watch this video which celebrates 50 years of La Leche league: